December 8, 2010

School-Based Program Effective In Helping Adolescents

A school-based intervention program helped New York City high school students with moderate to severe asthma better manage their symptoms, dramatically reducing the need for urgent care, including hospitalizations and emergency room visits, according to a study published online in the American Journal of Respiratory and Critical Care Medicine.

Students in the eight-week program reported a 28% reduction in acute medical visits, a 49% reduction in emergency department visits, and a 76% reduction in hospitalizations compared with asthmatic students who did not participate in the program. The program participants also experienced a 31% reduction in night awakenings, and a 42% reduction in activity restriction due to asthma, according to the study.

"The program helps teach adolescents the steps they can take to gain control of their symptoms, and learn about treatment options," says co-author Jean-Marie Bruzzese, PhD, assistant professor of child and adolescent psychiatry at NYU Langone Medical Center. "We found that it was effective in improving asthma self-management, reducing night wakening due to symptoms and the need for urgent healthcare in low-income, urban minority adolescents," she says.

The intensive program, called the Asthma Self-Management for Adolescents (ASMA), helped adolescents learn key facts about their disease, dispelled myths about medication, and showed how to better manage asthma using medication and controlling environmental triggers, according to the study.

Asthma affects some 6.7 million children in the United States. The respiratory disease, which causes narrowing of the lung's airways leading to wheezing, shortness of breath, and other symptoms, can result in school absences and lost classroom time. Research has shown that adolescents are less likely to receive regular medical care compared to younger children, and minority adolescents are less likely to use preventive medicine than white, non Hispanic youths. According to previous studies, the South Bronx has among the highest incidences of asthma hospital admissions in New York City, and the prevalence of asthma is three times higher than the national average in some schools in the Bronx.

"The ASMA program addresses an illness with a high public health significance," says Dr. Bruzzese. "It can serve as a model for other populations of adolescents, including those in rural and suburban communities, or for adolescents with other chronic illnesses."

The researchers targeted five high schools in the Bronx, Brooklyn and Manhattan with a predominately African American and Latino student body because these youth are the most at risk for asthma. They enrolled 345 students from the 9th and 10th grades who reported through a survey to be diagnosed with asthma. The students experienced moderate to severe persistent asthma symptoms and used asthma medications in the previous 12 months. The students were then randomly assigned to the school-based intervention or a control group. Of the enrolled students, 46% were Latino and 31% African American.

The students in the ASMA program participated in three educational group sessions and five individual coaching sessions. They kept a diary of their symptoms, noted when they took medications, and how they responded to environmental triggers. They also received coaching to teach them how to communicate their symptoms and other aspects of their condition to their medical provider, and they learned how to overcome barriers in carrying out the treatment plan, among other instructions.